Leaders in the payer space are investing in new technologies, population health and their teams in 2024.
The 21 leaders featured in this article, part of an ongoing series, are all speaking at Becker's 2024 payer roundtables. This includes our spring Payer Issues Roundtable, which is set for April 8-9, 2024, at the Hyatt Regency in Chicago. Some executives will also speak at our fall Payer Issues Roundtable, which is set for Nov. 4-6, 2024, at the Hyatt Regency in Chicago.
If you work at a health plan and would like to join as a speaker in November, contact Randi Haseman at rhaseman@beckershealthcare.com.
Question: What is the biggest investment you'll make this year?
Abdou Bah. Senior Vice President of Medical Management and Chief Health Equity Officer of EmblemHealth (New York City): EmblemHealth is investing significantly in technology, care coordination and community presence to reduce health disparities and improve health outcomes for our members. We are using technology to enhance our ability to capture additional and more robust demographic and other member data to make informed decisions about improving population health on a neighborhood-by-neighborhood level. We are also expanding our Neighborhood Care locations where members and non-members get personalized support for social factors impacting health like food, housing, transportation to appointments and more, in addition to wellness screening events, classes and educational resources, all free of charge. Our investments in technology and serving our communities in unique ways provide us with insights that we use to coordinate care and drive improvements in the health status of our members.
Paige Brogan. CalAIM Principal at Blue Shield of California (Oakland): [Our] biggest investment is definitely population health management.
Damanjeet Chaubey, MD. Vice President, Clinical Affairs at Clover Health (Nashville, Tenn.):
Areas of focus:
1. Reduce spend in low-value care — preventable acute care utilization for chronic disease management
2. Impact of [machine learning]/AI-generated data with clinical assessments for early identification of disease and treatment
3. Workforce competency assessment and training
4. Patient engagement in "managing their health"
Henriette Coetzer, MD. Chief Medical Officer of Blue Health Intelligence (Chicago): Staying human. In our rapidly changing health landscape, it's easy to let the transformational potential of new technology like AI and powerful machine learning models steal the spotlight, especially as it relates to data. But at Blue Health Intelligence, we're investing even more in our collaborative partnerships to help make an even greater impact for our clients. By listening to each other, we spark a synergy that unlocks our limitless potential to solve problems creatively. And when we combine the collective experience of our clinical, data and health payer experience with new technology and the magnitude of our longitudinal data set, there's even greater opportunities than ever before to work together to increase the value we're able to deliver to payers and their members.
Rushil Desai. CEO of Aetna Better Health of Illinois (Chicago): This year, as in past years, Aetna Better Health of Illinois continues to invest in digital technology to simplify the day-to-day experience for our providers. We're further investing in artificial intelligence, intuitive digital tools and automated systems to help relieve administrative burden. Our primary goal is to enable alternative payment models that minimize provider burden and ensure the best and most clinically appropriate care for our members. We are laser-focused on working with our providers to drive quality outcomes via real-time analytics on provider portals.
Stacy Edgar. Chief Executive Officer and Founder of Venteur (Berkeley, Calif.): This year we plan to invest in reaching those who are most impacted by the rising cost of healthcare. Mom-and-pop businesses like your local HVAC and plumbing companies run on such low margins that a premium increase can literally be the difference between profitability and losing money. By bringing [individual coverage health reimbursement arrangements] to these companies, we'll help thousands of small businesses provide higher quality and more affordable healthcare while also thinking about what’s best for the sustainability of their businesses. ICHRA can revitalize Main Street America if it gets adopted more widely.
Paige Franklin. CEO of Aetna Better Health of Kentucky (Louisville): Community is at the heart of our investment strategy. By fostering meaningful face-to-face relationships with stakeholders and financially supporting local health and wellness initiatives, we are intentional about dedicating substantial resources where our members live and work. From partnering with nationally recognized groups to working alongside community food banks, our investments are helping build stronger, healthier communities.
Joe Glinka. Director, HealthChoices at Highmark Wholecare (Pittsburgh): Our biggest investment will be made on behalf of our members, and it includes the time, energy and tangible resources needed to enhance the broad healthcare ecosystem that drives desired health outcomes for people in need. This encompasses refinement and purposeful execution of our clinical platform, connecting our members with timely and relevant nonclinical services, deepening our provider collaborations and embracing our large network of community-based partners to identify strategic community engagement opportunities. We will invest similarly into our enterprise's new West Virginia Medicaid market later this summer. Finally, we will transition investment(s) made during the Medicaid continuous enrollment unwinding period (redetermination) into a business-as-usual posture, to help ensure continuity of healthcare coverage for all Medicaid beneficiaries, not only Highmark Wholecare members.
Tom Grote. CEO of Banner | Aetna (Phoenix): Our biggest area of investment in 2024 is around the member onboarding experience. We recently launched a high-touch effort featuring personal, direct outreach via phone. The approach allows us to connect with new members and help them understand their benefits. Now we are adding to the initiative — for people who prefer SMS text, we are building a virtual assistant to provide an alternative to a live call. Either way, the program aims to give new members a warm welcome to Banner | Aetna and help them get the most out of their benefits.
Jessica Hohman, MD. President of Cleveland Clinic Accountable Care Organization: We are making a significant investment in growing our home-based post-acute care programs — specifically our SNF at Home and Acute Rehabilitation at Home programs. In partnership with Cleveland Clinic Home Care, we are investing in the provision of high-intensity skilled and non-skilled wraparound care for our patients with the goal of better supporting our patients' successful aging in the home. We have also been excited to recently receive a grant from West Health Institute to further support our mission of being a Learning Health System in the integration of these programs with Cleveland Clinic's Geriatric Emergency Departments.
Jack Hooper. CEO and Co-founder of Take Command Health (Richardson, Texas): This year we are investing in our team. We've set a goal as a leadership team to "advance our people," which isn't meant to just sound nice, but is critical if we're going to reach our goals to reform the health insurance landscape. Making defined contribution health insurance (via ICHRA) a seamless reality is hard and takes specialized knowledge. The quickest path for us to get there is to continue growing with the people we have. We're investing in coaching for teams and individuals, professional development and mentoring.
Michael Hunn. CEO of CalOptima Health (Orange, Calif.): Our Medicaid health plan with almost 1 million members here in Orange County, will make significant investments in IT infrastructure to support cybersecurity, as well as provider and member connectivity. We are seeking to achieve same-day treatment authorizations (85% there already) and same-day claims payments (clean claims are currently paid in about 11 days.)
Edward Juhn, MD. Chief Quality Officer of Inland Empire Health Plan (Rancho Cucamonga, Calif.): At Inland Empire Health Plan, the most impactful steps we will take in 2024 to improve the quality outcomes for our 1.5 million members include a combination of financial and relational investments. In addition to our increased funding for IEHP's 2024 Global Quality Pay For Performance program — now at $288.9 million — we will foster relationships as we drive a culture of quality within our organization and among our community partners. Our goals are to make the following significant investments throughout the remainder of this year:
- Executing our "Every Interaction, Every Opportunity: Quality Starts with Me" campaign, which focuses on relationships in an environment of quality care, leading to quality outcome breakthroughs and better support for our members, their families and the expansive Inland Empire communities in which we live and work.
- Returning to my medical practice roots by seeing patients in Barstow, Calif. (stay tuned for details about what will surely be meaningful encounters.)
- Building on the momentum of accountability shared in the IEHP 2024 Quality Report, which transparently showcases our accomplishments and opportunities for improvement in our quality journey.
Our biggest successes in 2024 will result from this melding of IEHP's financial resources with the investment of "being present" for the people we are honored to serve.
Jaja Okigwe. CEO of First Choice Health (Seattle): Our biggest expense is really people, so it comes as no shock that the biggest investment will all be about people. We have fully embraced being a hybrid and remote workforce, so making sure we can create connections across the workplace is consuming a large amount of our time. What does that mean? Being proactive around identifying and mentoring up-and-coming talent, creating opportunities to connect beyond work even when remote, investing in travel for group meetings, and developing better communication tools to keep everyone in the loop.
Jennifer Shermo. Chief Growth Officer of Security Health Plan of Wisconsin (Marshfield): The biggest investment we are making this year is enhancing our third-party administration services. We know this is a growing market and in-demand by many large to midsize employers. In fact, in our state, more people (more than 50% of total population) are covered through self-insured benefits than any other health coverage/insurance. We have a unique opportunity to provide services that create real value for employers and their employees.
Don Stiffler. Chief Revenue and Growth Officer at Commonwealth Care Alliance (Boston): Commonwealth Care Alliance traces its origins to the 1970s as a primary care clinic founded on a vision to fundamentally change healthcare delivery for people with the most significant needs. Since then, we have expanded from our roots as a specialized medical and behavioral health provider, to a national healthcare services organization that has pioneered care delivery solutions and technologies that help our members.
This year CCA is working alongside members — most of whom are dually eligible for Medicare and Medicaid or people with Medicare who are very close to Medicaid eligibility — providers, and other internal and external stakeholders, to support the continued evolution of our unique model of uncommon care. CCA will leverage a combination of investments in new technologies and processes to ensure that while our care model continues to grow and adapt to the ever-evolving needs and goals of our members, providers and staff, we remain ahead of the curve and true to our DNA: meeting those with the most significant needs with individualized, high-quality care.
Barry Streit, Senior Vice President, Growth at Essence Healthcare (Maryland Heights, Mo.): Our biggest investment this year will be in creating a modernized experience tailored specifically for a new generation of Medicare consumers, particularly the late-stage boomers entering the Medicare space. We are investing in tailored benefits that resonate with their preferences and lifestyles, enhancing preventive care services and providing access to a variety of digital health solutions that make high-quality care more convenient. As a health plan founded by physicians, we remain strongly committed to the belief that in order to provide the best care for our members, we must also offer our providers the very best experience. We are likewise continuing to prioritize investments in technology that will offer our physician partners the most actionable data and support to help them deliver on our tradition of five-star care.
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): In order to provide the very best to our members, it's critical that our team is at its best. There is no question that the biggest investment I will make this year is in our people, with key goals around succession planning, career pathing, onboarding and training, mentorship, coaching, and building a positive team culture. Ensuring that our team feels psychologically safe to admit mistakes, take risks and share new ideas without fear of embarrassment or negative consequences from teammates or leaders is critical. I also really lean into ensuring my team understands the importance of self-care and time to recover, whether that be through exercise, journaling, meditation, time with close friends or time away from work. And, I build this concept of "wellness" into our schedules, particularly when we are traveling. I don’t start our day at 8 a.m. if I can avoid it. Instead, I build in "wellness time" for the team between 6 a.m. and 8 a.m., with a 9 a.m. meeting start time. Or, I block out "wellness time" from 4 p.m. to 6 p.m., with dinner at 7 p.m. Creating space for sleep, rest, a workout, catching up on emails, or meditation, gives our team a much-needed breather and reinforces that wellness is a priority for all of us, even in the midst of work. In a 24/7 world, we need to allow people the freedom to work hard, but also to take breaks, encourage whole-person health, and share strategies for managing energy. Healthy people create healthy outcomes. That's the goal and the investment — to create a healthy culture where our people thrive.
Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): Atrio Health Plans is in the second phase of an enterprisewide tech refresh. We are implementing the Allymar Health MAS (Medicare Advantage Suite) system. Phase one took place last fall, when we implemented the enrollment feature in advance of the annual enrollment period. In January we went live with their claims module. We are partnering with Allymar on our risk adjustment program also. January was also when we launched the Acuity NXT utilization management module (we already use Acuity NXT for appeals and grievance and care management). The investment to update our technology will allow Atrio to stay competitive with its larger market competitors.
Troy Williams. Vice President of Hospital Partnerships at First Choice Health Network (Seattle): Honestly, I have a pretty significant personal investment as father of the bride for my daughter's wedding next year. Professionally, we are investing in our teams. First Choice has launched a series of extended benefits, employee resource groups and events in our new office space to bring people together, celebrate our work and inspire collaboration.
Debbie Zimmerman, MD. Chief Medical Officer of Lumeris and Essence Healthcare (Maryland Heights, Mo.): One of our greatest accomplishments has been Essence Healthcare's five-star plan rating for the past three years, and we remain focused on the quality and experience we provide our beneficiaries. Looking ahead, one key area of investment will be new technologies that leverage our advanced data and analytics to improve how we identify high-risk patients and deploy the right resources, including both technology and clinicians. Technology now enables us to improve how we stratify our diverse patient populations, ensuring that provider interventions yield the most meaningful and effective outcomes, fostering a truly patient-centered model of care that promotes active collaboration and shared decision-making among patients, families, caregivers and providers.